Meeting Information

Attendee Pass: HTAMeet

Chair:  Caroline Macumber

Scribe: Reuben Daniels


Attendee type:

H - HTA Member

O - observer

L - liaison


P - present

A - Apologies



HAJulie JamesBlue Wave Informatics LLP

Roel Barelds

Precipius b.v.

HPSusan MatneyIntermountain Health
Sylvia ThunHL7 Germany
HPCarol MacumberClinical Architecture
HPReuben DanielsSaludax
HPDavera GabrielJohns Hopkins University Institute for Clinical and Translational Research

Wayne Kubick


Suzy RoySNOMED International
OPAndrea MacLeanCanada Health Infoway
Soraya AssarMathematica
OPTed KleinKlein Consulting / HL7 UTG / Vocabulary WG CoChair
Jessica BotaApelon
OPRob HausamVocabulary WG CoChair
LPRob McClureUS Realm Liason
OPCarmela CoudercVocab WG CoChair

Minutes of Teleconference 2020-06-24

Motion to accept proposed and accepted.

Agenda Topics

Agenda Outline

Agenda Item


Meeting Minutes from Discussion



Minutes Approval

HTA Membership


Quorum is met

Motion to approve Minutes proposed

Roel moves, Devera seconds: Motion 10-0-0

Any others wish to volunteer for balance the "turnover"?  Julie is happy to volunteer (as I think it's my position that's unbalanced things as it is)

Wayne has reached out:

  • Susan has replied with interest.
  • Still awaiting a response from Sylvia
TopicExternal SDO Issues or additional topicsContinuous

Carol and Suzy Roy 

and Sara Armson

From the last meeting: Suggested wording for Co-Chair List announcement

Title: Updates to Licensing for LOINC and to the HTA External Terminologies Content

Body of email:

The HL7 Terminology Authority (HTA) is notifying all co-chairs of HL7 WG that LOINC has, this June, updated its license agreement for use of the LOINC - Logical Observation Identifiers, Names and Codes - terminology.  Specific wording must be used in any product or service utilizing LOINC; this wording is provided for you in the "Arrangement or agreements with HL7 for use of content" on the LOINC - Logical Observation Identifiers, Names and Codes page of the HTA External Terminologies pages.

Since many of our HL7 products reference the use of LOINC, this is of relevance to most of you; please communicate it within your WG and especially to all how are working on materials for ballot and/or publication. 

The HTA is also taking this opportunity to update you about recent new content additions to the External Terminologies - Information pages on Confluence.  These include the Dartmouth Atlas of Health Care, ICD-10 Procedure Coding SystemInternational Standard Classification of Occupations 2008 (ISCO-08)

Please check, and if OK, Julie will post to the Co-Chair list

  • HTA meeting has approved release of the suggested wording.
TopicCode system "stub" creationNewCarol/Reuben

Support of implementer community process for creation of code system "stubs" and expected interaction with HTA"

Overarching question - Who has the official responsibility of governing the creation of these external codesystem stubs?

Suggestion from Julie to take the discussion forward:

1) Obviously history influences a current situation.  The requirement is to learn from history and do better, not repeat it. My personal observation on the discussion from last meeting was that "we" have inherited issues that technology (specifically in the MIF) "created" - that are the main terminology using community both were and are largely unaware of and which had little if any value to their business.

2) Continuing to "maintain" (using that in its broadest sense) content that is "unreliable" is unwise, and in the long run is a disservice to the community we aim to serve.    There was a desire to "clean up" stubs but there was no sense of who would be responsible for this.

3) Suggestion: develop a governance and maturity process for external code system use for code systems not on the HTA pages (yet)  This may be very naive, but having sat through all the discussion last meeting, if this is too naive, maybe our existing set up is too complex ?

a) Have a "table" with minimum information requirements to "get things to work" especially for FHIR processes (siting a code system, or referencing one via a value set); without this - no content; no new code system "stub" resource in UTG.  Use the HTA pages framework as initial - use MUSCOW for the various sections.  

b) Set time frame for full content as per HTA pages to be provided using the HTA process.  If not provided, then code system resource stub gets "retired" (hope that is possible!)

For "old content" - start a retirement process......Ask the community about use of code system....if no response....retire.

  • Rob McClure noted that we need to consider use of NCI Thesaurus vs NCI Meta-thesaurus. Davera has offered to look into this.
  • Carmela provided a link for discussion: Policy on Maintenance of External Code System Identifiers (URIs)
  • Carol: Given the experience with NUCC, we can improve our process by communicating to the implementer community through a post in the Zulip Implementers channel.
  • Rob McClure noted that:
    • the NUCC issue started with the creation of a URL within US Core.
    • restricting the ability for IG developers to create new URLs, may cause angst.
    • we should try and figure out which URLs are required before IG developers need it and then resort to creating their own.
    • we should also strongly encourage code system IP owners to adopt our previously created URLs
    • there was an assumption that the implementer community can adapt to changes in URLs.
    • can we work out a process, where necessary, the implementer can adopt new URLs
  •  Ted noted that:
    • It is untenable for IG developers to wait weeks or longer for a URL from the IP owner.
    • A way forward may be to not publish things that have not been endorsed by IP owners
  • Rob Hausam:
    • The expectation is that canonical URL will not change, or it should be rare.
  • Reuben:
    • we need to clarify the HL7 policy on whether or not we need to respect IP owners wishes with respect to URLs for their code systems
  • Rob McClure: The policy is clear - whatever is HL7 core is primary and IP owners wishes are secondary.
  • Rob Hausam: Disagreed with Rob McClure - it relates to domain names.
  • Carol: Rather than discussing here or in Zulip, we should collaboratively refine the policy as stated at this page: Policy on Maintenance of External Code System Identifiers (URIs)
  • Rob McClure: Great concerns about IG developers assigning an "" URLs for a code system (because HTA takes too long) as the easy default. It will lead to everyone using an "" URL and IP owners will be ignored.
  • Ted noted that the OID registry addressed this, but noted that this was easier because people don't care that much about OIDs vs URLs
  • REQUEST TO ALL: Everyone reviews the Policy on Maintenance of External Code System Identifiers (URIs) before the next HTA and Vocab call.
  • Rob McClure: Noted it is reasonable for us to request that there be a process whereby people who are creating FHIR artefacts can create a code system URL without having to wait for HTA to figure out the endorsed URL and then have that change to the endorsed URL later. Reuben agrees and would add that the interim created URL needs to follow a set structure and conform to key requirements e.g. domain name, pattern, etc.
TopicCommunicating ChangeNewWayne

Need a process for communicating with the FHIR Community on potential breaking changes regarding external terminologies - advance warning etc. (ref NUCC codes)

Discussion needs to centre on having a plan to then put forward to Grahame and the FHIR community

  • Carmela notes that policy cannot be defined by Zulip discussions.
  • Rob McClure: The FHIR community firmly believes policy needs to happen via Zulip.
  • Reuben queried this policy would be part of the Policy on Maintenance of External Code System Identifiers (URIs). Carol confirmed.
  • Rob McClure suggested that newly created URLs should use
  • Ted noted we do not have a process for this yet, but it is a good way forward.
  • Reuben suggested that IG developers need to formally notify the HTA when external terminology resources are being used/adopted in their IGs so that the HTA can advise of existing URLs, or know which ones to pursue - as a matter of governance.
  • Ted and Rob both noted that a large number of external value sets will also need to be addressed too. Susan agreed.
  • Ted noted that only 3 people have participated on the vote on pCLOCD in UTG and requested that attendees vote:  
TopicUpdate to new PSS ProcessNewJulie/Wayne

Currently the process has this:

How should the question read?  Should we create a pick list based on the external systems listed in or the HTA page instead of asking people  to list the terminologies?

All external terminologies should be registered with HTA

  • Yes - hooks them into the HTA governance process
  • No - no HTA involvement
  • Unknown - recommend removing?

Picklist of known external terminologies is ideal. When the external terminology is no in the list, they pick other and use free text. 

Group feels strongly that we should extend this data capture to NIB. 


Julie: I have not done anything further about this..... please indicate what we might suggest....

  • Ran out of time - will table and discuss in a future meeting.
TopicWhen a code system is not a code systemNewJulie

Discussion of when a code system is not a code system but is a syntax….

  • Ran out of time - will table and discuss in a future meeting.
TopicUTG UpdateContinuousCarol/Jess
  • Ran out of time - will table and discuss in a future meeting.
TopicDiscussion with FHIR - Managing change in code system identificationReportReuben

Also FHIR Vocabulary Binding for Authors

Agreement was reached that one central place must be designated for management of external code systems, and Austin, Wayne, Grahame and Reuben all agreed that UTG was the correct place. However, there are issues with external code system content in the first content relase of UTG, and those need to be addressed before additional content can be migrated (including existing FHIR non-ballot bound terminology).

Need to start here at next meeting

  • Ran out of time - will table and discuss in a future meeting.
AdjournmentMeeting adjournedN/AJulie

Call adjourned at 20:00 UTC

Action Items

  • Reuben Daniels  create the ISCO-08 Page
  • Reuben Daniels to check with Joshua Procious to determine if we can transfer tickets from FHIR or UTG project to the HL7 JIRA project
  • Julie James will draft a note to co-chair list reintroducing the External Terminologies pages, pointing out LOINC update as an example, seeking feedback on changes and pointing out recent new additions (Dartmouth Health Atlas, ICD10PCS, ISOC-08 etc..)

  • Julie James  to create agenda for next joint on 08 July 2020
  • 8-Jul-2020:Davera Gabriel will run with NCI Thesaurus vs NCI Meta-thesaurus matter.
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